title: Laser lead extraction to facilitate cardiac implantable electronic device upgrade and revision in the presence of central venous obstruction.
abstract: OBJECTIVE
  The number of procedures involving upgrade or revision of cardiac implantable electronic devices (CIEDs) is increasing and the risks of adding additional leads are significant. Central venous occlusion in patients with pre-existing devices is often asymptomatic and optimal management of such patients in need of device revision/upgrade is not clear. We sought to assess our use of laser lead extraction in overcoming venous obstruction.
  
  
  RESULTS
  Patients in need of device upgrade/revision underwent pre-procedure venography to assess venous patency. In patients with venous occlusion or stenosis severe enough to preclude passage of a hydrophilic guide wire, laser lead extraction with retention of the outer sheath in the vasculature was performed with the aim of maintaining a patent channel through which new leads could be implanted. Data were recorded on a dedicated database and patient outcomes were assessed. Between July 2004 and April 2012, laser lead extractions were performed in 71 patients scheduled for device upgrade/revision who had occluded or functionally obstructed venous anatomy. New leads were successfully implanted across the obstruction in 67 (94%) cases. There were two major complications (infection) and four minor complications with no peri-procedural mortality. Device follow-up was satisfactory in 65 (92%) cases with mean follow-up up to 26 ± 19 months.
  
  
  CONCLUSIONS
  Laser lead extraction is a safe and effective option when managing patients with central venous obstruction in need of CIED revision or upgrade.
authors.affiliation: Cardiothoracic Department, Guy's and St Thomas' NHS Foundation Trust, 6th Floor East Wing, London SE1 7EH, UK.
authors.forename: Manav
authors.initials: M
authors.lastname: Sohal
authors.forename: Steven
authors.initials: S
authors.lastname: Williams
authors.forename: Majid
authors.initials: M
authors.lastname: Akhtar
authors.forename: Amit
authors.initials: A
authors.lastname: Shah
authors.forename: Zhong
authors.initials: Z
authors.lastname: Chen
authors.forename: Matthew
authors.initials: M
authors.lastname: Wright
authors.forename: Mark
authors.initials: M
authors.lastname: O'Neill
authors.forename: Nik
authors.initials: N
authors.lastname: Patel
authors.forename: Shoaib
authors.initials: S
authors.lastname: Hamid
authors.forename: Michael
authors.initials: M
authors.lastname: Cooklin
authors.forename: Cliff
authors.initials: C
authors.lastname: Bucknall
authors.forename: Julian
authors.initials: J
authors.lastname: Bostock
authors.forename: Jaswinder
authors.initials: J
authors.lastname: Gill
authors.forename: Christopher Aldo
authors.initials: CA
authors.lastname: Rinaldi
mesh_terms: D058409:Cardiac Resynchronization Therapy Devices; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D017147:Defibrillators, Implantable; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D004567:Electrodes, Implanted; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014689:Venous Insufficiency / Q000601:surgery*
keywords: Cardiac resynchronization therapy; Implantable cardiac defibrillator; Laser lead extraction; Pacemaker; Venous obstruction